Nikola Knezevic, Tomislav Kulis, Marjan Maric, Vladimir Ferencak, Josip Pasini, Zeljko Kastelan,
University of Zagreb, Medical School, University Hospital Center Zagreb, University Department of Urology, Zagreb, Croatia
Symptomatic postoperative lymphoceles after renal transplantation appear in 4 to 6% of patients. Best results for treatment of symptomatic post renal transplant lymphoceles are achieved by operative fenestration and marsupialisation with internal peritoneal drainage. Due to operative stress of open procedure, laparoscopic approach is becoming more accepted. We report our experience and results with this technique.
We analysed medical records of patients that underwent renal transplantation at our Clinic between January 2008 and December 2013.
From January 2008 to December 2013 we laparoscopically treated 27 out of the 715 transplanted patients (15 men and 12 women) with symptomatic pelvic lymphocele causing deterioration of renal function or oedema of the leg. Median time of presentation after the transplantation was 65 days. In all patients we used transperitoneal laparoscopic approach, the lymphoceles were fenestrated and marsupialised at peritoneum to prevent later closure.
Laparoscopic treatment was successful in 25 patients.
Two patients later presented with symptomatic recurrences, one was treated with laparoscopic approach and the other with percutaneous drainage.
Out of the 27 patients that underwent this procedure 7 had prior attempts of sclerosation which caused thickening of lymphocele wall and subsequent difficulty in intraoperative lymphocele identification. In all the cases there were no conversions to open procedure and there were no iatrogenic injuries to the ureter. In one patient there was injury to the urinary bladder that was recognised and treated intraoperatively. In one case along with the fenestration of the lymphocele, patient`s native kidney was removed.
Conclusions: Due to disrupted anatomical relations in the region of transplanted kidney, and variable position of lymphocele, we would recommend to perform computerized tomography prior to operation. Since ureteral injuries are reported as most frequent complication, placement of ureteral stent can be helpful as well as percutaneous drainage catheter. Laparoscopic fenestration is effective and feasible technique and we would recommend it for treatment of large symptomatic post renal transplant lymphoceles.